78171A_Grinnan, Susan_20210505

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�` P-CAMA ; '!`DREDGE & FILL -, I g C D
GENERAL PERMIT Prev►ouisPermit /
J t,l,:� Psoiiificaton Complete Reissue Partial Reissue Date previous permit astatd
As authorhed by the state of Notch Carolina, Department of Ewm war iiental Quality anNC-AC
�J (( '.LpO t 7A,j S ,
d ate Coauai Resources Commission in an ww of environmental concern pursuant to I SA NC -AC! �l t
aaadted_
AWcw Name 5 k S *,in 05 r - A to OR 11 Project Location: County Alzj) o-C e-
Add►m 3 3.5a Pat A +-- Street Address/ State Road/ Lot #(s) L O +
City & v.; "k-, M State VA zip :7--3 q z 60 VJ, `) Jr n Cit.
Phonefi)(oath 3/�%` 0 E-Mad y5an_. twown04� Subdivision Old N _ _�� S�cp
Authorized Agent HEM 9 t' na-- _ --_ _— -- City N a J % fe 0.d"L zip Z? 9 s
J R�er Bashi pa3 u a �.►
Affected � �TA � �lTli Phone IP ( ).
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AEC(s): rtINF 1H 1liA f+fitA Adj. Mr.
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Ciosefft f"bM. Wltr
Type of Project/ Activity
Pier (dock) length
Fixed P lat"%) -- - - .
Fieatrng Pkwortrysl
Firwr Pier(s) '
Grain length
number
Bulkhead' Riprap {math '
wg first ance WON). e
max distance effshere
t
Bann, channel j 19
f igsSk eF (t---
cubic yards 4 O Gs/
Boat ramp
BoathciLFW Boatlift `
Beach &Admw%
other 3 f I t P'i I"rtSs
r41L I t: is
shoreline Length two+ — � P
t t
SAV not sure Yes G,
Moratormw GN yes no
Photos: AL
Wawcr Attached arm
A building permit may be reclu rt-i by -
( Note Local Planning )u now-cion)
Notes( Special Conditioris d
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See note on hack roWding River Bassin, rules.
Lb�
erx or Applicant Ported Name
S/r'� a ** Please � complimice �etnent back of prri,ut •'
- _ LI S i
Aplikad-Faii(s) Check 0
Pe. mot Officer s Printed Naae
Si
issv,ng D e
/Y/Z-f
piratian Date
RAP

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Name of Prupway 0anvr Appl:ring ftw Permit:
Mailing AA&VW
Lid 1i kZ' I IVA ' ;01(4 t
auths-inzeO tap" j� )a
hochulf. for The purpose of xppfv ing fiW6911 ObWuiad IN LAMA Permits ftux-asm so
HINtAll Or CON et
at 4my proper" located at) 6h IYN
This certification is valid thru i date)_ ................ . 11
Prt4wrty Owner

TNr, msp b O epxed
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ham 4106 used ra rM
1tv"mory of the reei
1
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popery for tea
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pxpowt. Primry
mfomtetion Sources Such
Jf rKardeO deed% WMR
w1k and otter p,,mery
P-WK Words shautd be
ronewted ro, v*, kzti
Of the Jf m jkm
contained In this mep.
200 W Dolphin CT
Naqs Head NC. 27959
Parcel. 006214000
Pin 080113040731
Owners: Grinnan, Susan -Primary
Owner
Blair, Monica -Primary Owner
Building Value: $140,000
Land Value: $162,000
Misc Value. $12,600
Total Value: $314,600
;00
4,4
Tax District. Nags Head
Subdivision: Old Nags Head Cove Ser A
Lot BLK-Sec: Lot. 89 81k. Sec A
Property Use: Residential
Building Type: Beach Box
Year Built 1973

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DoaSign Envelope ID: OOD1A7F4-0599-4DCA-9565-3881087892BF
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner ��. t M� � _ 1 \r Y ,
Project Address `"� L( �_c r 1 v 0s`
(Lot or Street #, Street & Road_ City & County) R t
Agent's Name # 11�C Y` 1 I 1 Mailing Address: Po
Agent's phone* � ��.Q� 3�G 1�L & 1- , `,�, C C1
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
the ire proposing. A descri tion or drawln w imenaions must be rov�ded w►th thEs let#er. t
I have objections t>D this proposal. eve ections to this proposal. ,5e e
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City. NC, 27909. OCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to wive the setback,s,Z mustsign�_the a ap�pr�pl�at�`blank � b�el0.U_� lll�t )e�
1 �; = ..
I do wish to waive the 15' setback requirement.
(AppticantlProperty Owner Information)
.Signature
�kl SC.r­\
Print or Type Name
Mailing Address
0La%,r)Vn VIA 031Ll �
CityiStaterLp
F`;vL-I - _ 1)I I tr t C
Telephone Number / Email Address
L_ ` -
hare
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
,­ DocuSigned by:
1 A4 aff ryt,s 6v,
SiglyiM v F873483 .
Print or ryas Name Wit`+ c
Ili Yy-) C-
Maiiing Address `
cay/stete/zp
252-207-6143
Telephone Number / Email Address
Date=
'Valid for one calendar year after signature' Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that f own property adjacent to �_c-nn 's
property located at 1-:A00 W I
(Name of Props Owner)
r\la l ntl r r^ti.A 0
(Project Site: Address, Lot, Bl{ock, Roa i t:.)
�
on 1 in aC S 1A�' , N.C.
(Waterbody) (Cityrrown and/or County)
Agent's Name Mailing Address:" J�
Agent's phone #A'}') tC1 4q
T
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in descApt ion below or attach a site drawing)
� Du-
19
1 ? `� ) -r . _ D(A CAS 1 >"l
Mo f>icla Y� co
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if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM1 in wrfUng within 14 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27W9. DCM representatives can also be contacted at (252) 2"
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signature
Prinf or Type Ale
Mailing Address
iil-A it
City/State/Zip
`-t—ti4_�i_c}1
Te'l`ep�honte Number / /Email Address
Date
(Adjacent Property Owner Information)
S" ure*
Print ar # e ems
24
Ma ing Ad ress' _
��S,,I e2rp
14_
Telephone Nu er/Email A SS
'Valid for one calendar year after signature'
Date'

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